Specialty Provider Networks

eAlert b5872d32-77b2-492d-ae9e-9401d14f879d

<p>Recruiting and retaining high-quality health care providers, especially specialty providers, can be a struggle for many organizations. But it's especially challenging for Medicaid managed care plans, which must contend with historically low reimbursement rates.<br><br>
In the new Commonwealth Fund report, <a href="/cnlib/pub/enews_clickthrough.htm?enews_item_id=18139&return_url=http%3A%2F%2Fwww%2Ecmwf%2Eorg%2Fpublications%2Fpublications%5Fshow%2Ehtm%3Fdoc%5Fid%3D290918%26%23doc290918">Best Practices in Specialty Provider Recruitment and Retention: Challenges and Solutions,</a> Karen Brodsky, M.H.S., discusses results from a study of Medicaid managed care plans, conducted by the Association for Community Affiliated Plans (ACAP), that sought to examine barriers to provider recruitment and retention. Plans participating in the study reported an array of challenges, chief among them low payment rates, a general preference for privately insured patients, the scarcity of rural providers, and physicians' frustration with referral and pre-authorization processes.<br><br>

But solutions exist, Brodsky says. As detailed in four case studies, plan leaders are sustaining relationships with providers through regular and meaningful communications and outreach; technological enhancements that improve claims turnaround and facilitate authorizations and referrals; and financial incentives that reward high-quality care. Such strategies can help all health plans attract new providers, the report says, as well as improve quality of care, enhance member satisfaction, and achieve cost savings.<br><br></p>